title: Variation in definitions of urinary tract infections in spina bifida patients: a systematic review.
abstract: OBJECTIVE
  Urinary tract infections (UTIs) are a common source of morbidity among children with spina bifida (SB) and are a frequently reported outcome in studies of this patient population. However, the criteria for a diagnosis of UTI are often not stated. We evaluated the literature on SB patients for the criteria that authors use to define parameters in reporting UTI outcomes.
  
  
  METHODS
  Embase and Medline were queried with the medical subject heading terms “spinal dysraphism,” “myelomeningocele,” “infection,”and “urinary tract infection.” A second search with the exploded term“spina bifida” and “urinary tract infection” was performed. Original research studies reporting a UTI outcome in SB patients were included and evaluated by 2 independent reviewers for the presence of a UTI definition and diagnostic criteria.
  
  
  RESULTS
  We identified 872 publications, of which 124 met inclusion criteria. Forty-five of 124 (36.3%) studies reporting UTI as an outcome provided a definition of UTI. Of 124 studies, 28 (22.6%) were published in pediatric journals and 69 (55.6%) in urology journals. A definition of UTI was provided in 11 (39.3%) and 26 (37.7%) studies, respectively. “Fever,culture, and symptoms” defined a UTI in 17 of 45 studies. Journal category and presence of UTI definitions did not correlate (P = .71).
  
  
  CONCLUSIONS
  Explicit definitions for UTI are heterogeneous and infrequently applied in studies of SB patients, limiting study reliability and estimates of true UTI rates in this population. Future studies will benefit from the development and application of a standard definition for UTI in this population.
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Ramiro Jose
authors.initials: RJ
authors.lastname: Madden-Fuentes
authors.forename: Erin Rebekah
authors.initials: ER
authors.lastname: McNamara
authors.forename: Jessica Catherine
authors.initials: JC
authors.lastname: Lloyd
authors.forename: John Samuel
authors.initials: JS
authors.lastname: Wiener
authors.forename: Jonathan Charles
authors.initials: JC
authors.lastname: Routh
authors.forename: Patrick Casey
authors.initials: PC
authors.lastname: Seed
authors.forename: Sherry Sedberry
authors.initials: SS
authors.lastname: Ross
mesh_terms: D002648:Child; D015331:Cohort Studies; D018849:Controlled Clinical Trials as Topic; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D016135:Spinal Dysraphism / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology